Page 202 - E-Rate 2020-21 Workbook

Section 54.504 of the Federal Communications Commission's rules requires all schools and libraries ordering services that are eligible for and seeking universal
service discounts to submit an application for such discounts by filing this Services Ordered and Certification Form (FCC Form 471) with the Universal Service
Administrator. 47 C.F.R. § 54.504. The collection of information stems from the Commission's authority under Section 254 of the Communications Act of 1934, as
amended. 47 U.S.C. § 254. The data in the report will be used to ensure that schools and libraries comply with the application requirements for universal service
discounts contained in 47 C.F.R. § 54.504. Schools and libraries must file this form themselves or as part of a consortium. An agency may not conduct or sponsor,
and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The FCC is authorized under the
Communications Act of 1934, as amended, to collect the information we request in this form. We will use the information you provide to determine whether approving
your application for universal service discounts is in the public interest. If we believe there may be a violation or a potential violation of any applicable statute,
regulation, rule or order, your application may be referred to the Federal, state, or local agency responsible for investigating, prosecuting, enforcing, or implementing
the statute, rule, regulation or order. In certain cases, the information in your application for universal service discounts may be disclosed to the Department of
Justice or a court or adjudicative body when (a) the FCC; or (b) any employee of the FCC; or (c) the United States Government is a party of a proceeding before
the body or has an interest in the proceeding. In addition, consistent with the Communications Act of 1934, FCC regulations and orders, the Freedom of Information
Act, 5 U.S.C. § 552, or other applicable law, information provided in or submitted with this form or in response to subsequent inquiries may be disclosed to the
public. If you owe a past due debt to the Federal government, the information you provide may also be disclosed to the Department of the Treasury Financial
Management Service, other Federal agencies and/or your employer to offset your salary, IRS tax refund or other payments to collect that debt. The FCC may also
provide the information to these agencies through the matching of computer records when authorized. If you do not provide the information we request on the form,
the FCC or the Universal Service Administrator may delay processing of your application for universal service discounts or may return your application without
action. The foregoing Notice is required by the Paperwork Reduction Act of 1995, Pub. L. No. 104-13, 44 U.S.C. § 3501, et seq. Public reporting burden for this
collection of information is estimated to average 4.5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, completing, and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of
this collection of information, including suggestions for reducing the reporting burden to the Federal Communications Commission, Performance Evaluation and
Records Management, Washington, DC 20554. We also will accept your comments via the email if you send them to PRA@FCC.gov. DO NOT SEND COMPLETED
WORKSHEETS TO THESE ADDRESSES.
Authorized Person
Title: Superintendent Name: Jennifer Williams

Phone: 580-332-1444 Email: jwilliams@kelloggllc.com

Address: 2020 ERATE DRIVE Employer: ABCD SCHOOL DISTRICT
ADA, PONTOTOC, OK 74820

14-Jul-2019 08:02:39 EDT
Certified Timestamp

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